Second-line randomized trials in epithelial ovarian cancer

Important issues in the treatment of patients with recurrent ovarian cancer (ROC) are 1) to delay the time to symptomatic disease, 2) to reduce symptoms in case of symptomatic disease, 3) to optimize quality of life, and 4) to prolong overall survival. However, response assessment and recording of treatment-induced side effects in general get most attention. The likelihood of response to chemotherapy is directly proportional to the length of time between the end of primary chemotherapy and the date of recurrence. Also, the aggressiveness of the recurrence seems related to the prior biological pace of disease progression. For these reasons different disease categories have been identified, ie, platinum/taxane-refractory disease (progressive during first-line stabilization as best response), persistent disease (partial response to first-line therapy), platinum/taxane-resistant disease (clinical complete response [CCR] or no evidence of disease [NED] to/after first line and relapse <6 months), and platinum/taxane-sensitive disease (CCR or NED to/after first line and relapse >6 months). Randomized trials in these different categories did not show a benefit of maintenance or consolidation therapies after first-line therapy but did show differences in tolerability and efficacy (in platinum/taxane-sensitive disease) of different single agents and indicated that in specific circumstances combination chemotherapy is superior to single-agent chemotherapy. However, in all circumstances other aspects such as toxicity (and earlier experienced toxicity), clinical condition, convenience of administration, costs, and patient preference should be considered in the final selection of treatment.